Writing can change your life. It has been shown to decrease pain if you writing 15 minutes twice a day. Write even rubbish and then the brain will open up and you will find you are writing about things stuck in your brain. Once you have written, tear the page up and throw it away.

Another helpful tool is a diary for tasks. At night, to avoid thinking in a spiraling useless way, mind is just going and going and going, rather write in those 15 minutes about your tasks.

An example of an effective diary, is keeping a list of tasks as:

IMPORTANT and URGENT: IU do soon and spend time on task

IMPORTANT and NON URGENT: IN – needs time. Put off for another day.

NOT IMPORTANT and URGENT:NU – do soon and don’t spend a lot of time on it.

NOT IMPORTANT and NOT URGENT:NN  put off and don’t waste time on it.

Keeping a diary can help you overthinking and over planning. Trying to control every moment of every day is exhausting. The more control you seek, the more exhausted you will be.

Good luck

Judy

I am so thrilled at my new program’s positive outcomes. I’d like to share success stories. Yesterday, two patients reporting pain maximum 8 to 10 out of 10 are now down to ZERO pain. These are remarkable results and of course not always possible.

Chronic pain has biological causes (Nociceptive Pain) that can’t always be fixed. But Nociplastic pain can be healed completely.  If you’d like to learn more about ways to heal, have a look at my very first animation video – second one on the home page.

Then click High Impact Pain. Even if you have significant biological causes for pain, like one patient who had proven nerve compression causing sciatica, you can heal – after 40 years of pain, her back pain and 2 year sciatica pain is now down to zero.

Good Luck.

Also – here is a link to Hannah’s resources for Post Motor Vehicle Trauma management.

Take care

Judy

I built this website because this question is so VERY difficult to answer. When patients come to me with severe pain but the investigations show ‘nothing is wrong’ it leaves them very frustrated. It’s so hard to explain. Let’s try.

Yesterday I had a patient come to me with a rash on her arm that flares up every few years. The rash is eczema. Why does she get eczema on that particular part of her arm and nowhere else. Turns out she had an injury to that arm a very long time ago. Instead of chronic pain, her Limbic System has given her only inflammation which results in a rash in the spot that was injured. 

Here is how it goes. I will try an make a video but I am very limited in my video making skills. Here’s the explanation. Injury —> nerves carry the message of the injury to the alarm brain (limbic system) and the alarm brain rings out the danger message – PAIN. If you touch a hot plate – instantly get pain warning you of the danger of heat so you can remove your finger.  Does that make sense?      Okay. Onwards. 

Say it’s a back injury and the pain goes away, but then comes back, and goes away and comes back and eventually stays. What is happening. 95% of the time, this pain is from a cycle of Pain causing alarm – when you are in pain – it is a negative stress and it can cause the alarm brain to go off —> When the alarm brain goes off, it automatically sends pain signals and inflammation. The inflammation is supposed to be for healing – as when you burn your finger – but when pain is chronic – the inflammation causes more problems.

Chronic inflammation along with chronic alarm can even lead to autoimmune diseases like rheumatoid arthritis and even psoriasis or eczema or even inflammation in heart and blood vessels. It’s bad news. 

Pain causes alarm and the alarm brain causes pain and inflammation. You are stuck in a deadly loop. Any extra stress makes the alarm brain ping even louder. By now, the alarm switch is broken and you are being warned of danger when there is none. So the problem is in your body – inflammation causing harm – and it’s in your brain – where the alarm brain is causing pain, inflammation, fatigue, poor concentration, mood changes. 

High-impact pain is very very very – did I mention very – hard to treat. 

Start with the basics. We have to move away from alarm. Every single time you have a twinge of pain – do the grounding technique – 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 think you can taste. This takes 30 seconds. Then take 2 healing breaths. Hand on the heart and palm on the lower belly. Fill the belly with air and then as you breathe out feel the belly going back to the spine. 

This creates a new pathway. If you stop giving oxygen to the pain pathway and feed this new pathway, you will build a healthier pathway and starve the pain pathway. It can takes 8 to 12 weeks. You don’t have to believe it works. JUST DO IT!

Build a new future.

Phew! Take care

Judy

Today I am having a conversation with a patient about acetaminophen with codeine. This patient has chronic pain – her pain is  high-impact pain. This means that her chronic pain has impacted her life in many ways. It affects her mood, her relationships with other people, her ability to work and to enjoy activities and life in general.

She came to me as a consult pain and she was taking acetaminophen and the highest dose of codeine but she was still experiencing very high pain levels. Codeine is a opioid that is different to others. The body has to change the codeine into morphine. This requires an enzyme called CYP2D6. There are genetic differences in how the body changes codeine to morphine. 

This patient was very keen to go off opioids. I suspected that she may be one of these people not converting codeine to morphine. Buprenorphine and naloxone was used to taper her off opioids and her reaction proved that she was actually almost opioid naive. Which meant she was hardly converting any codeine into morphine. Which means she was not really on opioids at all.

This difference in patients and how they metabolize codeine makes it a dangerous drug. Some people convert the codeine so well it can then lead to breathing difficulties and even death. This is why I try to stop patients from using codeine.

This patient is now off opioids entirely and we are embarking on a journey of pain management without using opioids. This is a much safer strategy and if done correctly will give equal results to those patients using opioids without pain strategies. To prove this point, I will discuss another patient who had pain for over 40 years and is now pain free except for usual pain – as when she is climbing a mountain.

This patient had back pain for 40 years. Working on my pain program and the pain education, she is now pain free. 

Below is the pain program which you can try. I will add steps as I go along. 

Self-management for high-impact chronic pain.

Good luck

Have you noticed swelling in your lower legs? Puffy feet or ankles. Dents in the skin when you press against the bone?

That’s called pedal edema. The swelling can be a serious sign of heart disease, kidney, or liver. Please consult your healthcare provider.

It can also be from stress, for instance, if there is heat stress, the legs swell, usually the limbic system that then sends out a hormone called anti-diuretic hormone. ADH. This can also occur with emotional stress. The fingers and even the face can swell when the alarm center of the brain is sending out hormones to raise blood pressure. Water retention is made worse with salt.

Make sure you have your provider exclude serious conditions. But work on your alarm system. Lower inflammation.

Good luck

Judy

Today I have a patient with pain in his shoulder. He swears the pain is coming from his shoulder. He can feel and hear the crackling – which is of course fascia – but our bodies deceive us.

Think of a heart attack. People older than 65, especially women, especially diabetics, they often don’t have chest pain when they have a heart attack. They can get left (even right) arm and shoulder pain. When you have shoulder pain – check to see if the pain is worse when you are exerting yourself. If the pain comes when you exert yourself and then stops when you rest, then consider your heart.

Think about your gall bladder. If you have right shoulder pain – especially the tip of the shoulder, you could actually have gall bladder stones or inflammation.

My patient’s pain is with raising the arm. When he puts the left hand on his right shoulder and raises the elbow – he gets pain in the left shoulder. Typical of rotator cuff tendinosis. Sick fascia around tendons and muscles of the rotator cuff.

He also has pain moving the arm so that the humerus moves inside his joint. Maybe a bit of osteoarthritis.

Actually, when it comes to rotator cuff and osteoarthritis, really, exercising and stretching so that the fascia loosens up is what is really important. When you are afraid of pain, this makes every condition worse. Our bodies heal. We have forgotten how to move past pain. We are so busy relying on tests and doctors and physios to heal, we have forgotten that most injuries will heal if we can stop being afraid of pain.

If the shoulder exercises are not working – you probably also have problems elsewhere. Look to the neck and back as well. Don’t just exercise your shoulder. So do the stretches for Neck Pain and Upper Back pain and also do the Lower Inflammation exercises to reset your alarm in the brain.

Chronic pain is different to Acute Pain. We have to treat the tissues and the brain.

Take care

Judy

Unfortunately, in any situation in any place, you will always find bullies.

Bullies feed off reactions from their victims. They practice their bullying from childhood – all bullies have been taught their techniques from their caregivers or other older people in their families. They are experts.

We can’t change bullies. They are usually narcissists. The best revenge you can have on a narcissist is not to care. Why am I caring? Why do I react when I know the person is unfair and their behavior unacceptable?

The bully is sensing insecurity. Our insecurities usually come from early childhood shame. When was the first time that you felt “not good enough?” What age? If you had difficulties in childhood – check out Complex PTSD.

If you are lucky, this may have only happened when you entered the workplace. Perhaps you had a good childhood and are unprepared for people who are so mean.

Perhaps it’s more than that. Some men will use these bullying tactics as a form of sexual assault.

Explore all the options. Seek counselling. If you are being attacked, this is a serious cause for concern.

Stress causes 70% of chronic disease and early death. Use every technique you can to calm your body and your mind so that you can appear immune to the threat.

Take care.

Judy

Cannabis

Cannabis can seem like a harmless drug, but like any substance, it needs to be used with caution. I remember a professor telling me, if a drug doesn’t have a side effect, it doesn’t have an effect, and that is certainly true of cannabis. It has many side effects and the overall value of cannabis as a chronic pain management tool is still unproven by decent drug trials.

The risk of cannabis may outweigh the benefit. Adolescents in particular are at risk when they use cannabis. They are two to four times as likely to develop a substance use disorder and have an increased risk of mental health or neurological problems.

The elderly are also at risk. Is cannabis worth the risk of a lower IQ? Learning difficulties, earlier onset dementia, falls, psychosis, anxiety, and increased suicide risk are all side effects that occur with cannabis use.

Withdrawal symptoms after regular cannabis use include irritability, anger, aggression, anxiety, weight loss, restlessness, depressed mood, abdominal pain, tremors, fevers, chills, and headache.

Please speak to your healthcare provider about alternative management tools. I have had patients self-medicate their chronic pain with alcohol. Alcohol silently attacks muscles, including the heart, and the brain, kidneys, liver, and other organs. By the time alcohol damage shows itself, it is usually too late.

If you are using cannabis or alcohol to cope with your chronic pain, consider speaking to your doctor about other drugs. Opioids may be necessary in cases of overwhelming pain. They have significant side effects, especially in the elderly, and should be used to assist in the use of other chronic pain tools, like those in Step 2, Step 3, Step 5, Step 6, and Lower Inflammation.

It can be helpful to have someone with you to help you communicate your pain to your doctor/healthcare provider. Have the conversations necessary to make reasonable choices.

Unfortunately, there are too many patients without physicians. I believe healthcare needs to be changed. There are many patients who have incredible knowledge and resources – those who have learned to manage their pain. If only we could find a forum where these patients become the leaders helping others to heal. In the future, I see nurses and physician assistants working with patients in group settings for education and working individually with patients to tailor safe chronic pain management.

We are far from where we need to be to provide those in pain with relief. In BC, we are trying with Pain BC and Self Management BC to find help, but we have a long road ahead of us.

Take care all.

Judy

First rule out biology -BIO – there are many reasons for pain. Far too many of them are not detected through blood tests or imaging. Too often, we doctors miss the diagnosis. Then by the time the diagnosis is made, the acute pain has become chronic.

Tissue damage, inflammation, nerve damage – they are really hard to treat when there is chronic pain. Especially nerve pain is hard to treat. From the age of thirty, most of us have some form  of osteoarthritis. Unfortunately – the only treatment for that is exercise, stretching and surgeries – like back surgery or joint replacements. Surgeries usually help, but they don’t always help.

The biological part of pain is very complex. Severe tissue damage leads to scarring and nerve inflammation. The nerves and surrounding tissue change. Changes that are meant to help healing – inflammation – can eventually cause toxicity in the cells if the problem is present for more than a certain time (this can vary from injury to injury and person to person). So pain messages continue to flood the brain due to these changes.

Say you have a severe accident or even an accident which causes a feeling of great threat (like a car accident where you could have died or domestic violence), then the alarm center is altered. Central sensitization happens if the injuries are not immediately ‘fixed’ – which seldom happens if there is severe tissue damage or when you can’t escape a ‘bad’ situation at home.

Once we have exhausted the biological part – we’re stretching, we’re moving, we’re taking the medications that we can, and still there is not relief, then we really have to concentrate on the other areas of pain. BIO-PSYCHO-SOCIAL.

PSYCHO – TRAUMA – physical trauma, illness, environment, toxins and past childhood and adult trauma. Chronic pain is a trauma in itself. It robs you of power.

SOCIAL – Pain makes it almost impossible to use your energy to spend time with others. There is sometimes only enough energy to get through the day. It can cut you off from everyone.

Dealing with the biological part means that the nerve inflammation and tissue damage needs to be sorted. Use cold for swelling – 10 minutes on 10 minutes off; heat for comfort and soothing, stretching the fascia gently, and ventral vagal breath.

When the pain hits, if possible, immediately relax (very hard to do in pain) speak to the limbic system and say “you’re safe” then take ventral vagal breaths. It sounds so silly, but if you pull a face, or wince, or scrunch up, the alarm center is reinforced that there is danger and the pain pathway gets harder, stronger, more set in your brain.

Start with work on the alarm system. It is broken if you have chronic pain. It is very important to recognize that the pain messages you are receiving are false alarms. They do matter! They are causing your pain. But they are causing too much pain for the tissue damage that is present. You can’t trust your pain signal.

Start with making sure you get up every day at the same time. Get dressed, no matter how hard this is. Do your make up if that is what you used to do before you became ill. It is important to make these steps to normal.

I now the breathing. Judy and her bloody breathing. People don’t know how to breathe to lower alarm. Step 2.

I know you want to work. I know you link the work with your self image. And work at least gives you power and social connection. It gives you self respect. Work if that is what you need, but the most important is load! Pacing. If you have chronic pain, you have to take every 20 minutes off for at least 10 minutes to practice breathing and something like super brain yoga. You can do this in the chair. See this and the breathing in LOWER INFLAMMATION. 

Start:

Every 20 minutes – 5-4-3-2-1, superbrain yoga and a deep breath.

Chair yoga 3 times a week. Even if all you do is sit and watch the videos. Eventually do a few movements. Eventually you WILL complete the program. Commit to 3x a week chair yoga.

More to follow

Judy

Is this JUST anxiety. Oh No! Not Just. Stress and Anxiety affect every part of your life – your biology – inflammation, high blood pressure, high blood sugar, the list goes on and on.  Affects psychology – how you think about yourself. Affects you spiritually – how you see the world and what is perhaps beyond what we see in this world.

Shame is a response to not feeling good enough. How do you see yourself? Do you feel capable? Capable enough? Always consider the word enough. In a broken world with broken systems, we try to compensate for things we have no control over. People pleasers and perfectionists cause themselves enormous stress and body ills. Not just your body. Also affects those around you. Affects communities.

Notice shame responses. Where do you feel it in your body? Are you fiddling more than usual – fingers and hands moving. Foot can’t stop bouncing? How does your gut feel? Are you getting headaches? Is your blood pressure going up? Sweating from too high adrenaline. Hormones are running amuck.

Be curious – Ah. I’m having a shame response.

Next step – calm the limbic system – the alarm center of your brain. I do 5-4-3-2-1 grounding techniques. I am an Olympic breather. Gold medals all around. Super brain yoga takes a minute – all on Lower Inflammation.

Take the time

Take care

Judy